Abstract and Introduction
Abstract
Patient surges related to the COVID-19 pandemic, combined with the pre-existing and worsening nursing workforce shortage, have exacerbated the need to implement strategies that build a pathway to expand the current and future nursing workforce. Ideal strategies connect education and practice, based on supply and demand for healthcare professional skills. NursingNow, a global campaign that includes a USA initiative, declared the mission to elevate nurses and has called for them to be agents of change by leading innovative solutions to existing problems. This article highlights two such nurse-led innovation exemplars that fostered the connection of education and practice to engage interprofessional students. We describe the development and implementation of these initiatives and accomplishments achieved. The discussion reviews issues around contracts, compliance, and accreditation; incentives for partnerships; and the development of a health professional student corps. The call to action invites nurses, as the largest healthcare workforce, to consider leadership roles in efforts to incentivize centralized solutions and ongoing academic-practice partnerships.
Introduction
When the coronavirus pandemic of 2019 (COVID-19) came to the United States (U.S.) in early 2020, all aspects of healthcare were impacted. The virus led to more than 50 million infections and 800,000 deaths in the US by the end of 2021 and overwhelmed the healthcare system (AJMC, 2021), forcing systems to adapt to meet the needs of patients. In a 2021 survey of healthcare leaders in North Carolina (NC), 80% of respondents reported experiencing a workforce shortage at the time of the survey, with 52% claiming it was worse than before the pandemic (Jones et al., 2021).
Both prior to and during the pandemic, the two most common types of workers in short supply were registered nurses (RNs) and nursing assistants (Jones et al., 2021). Despite these shortages, nurses, who make up the largest portion of the healthcare workforce, have been at the center of the pandemic relief efforts (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021a). RNs have contributed across the health continuum, from contact tracing within the community to caring for the sickest patients in intensive care units (American Association of Colleges of Nursing, 2020).
Not only have working nurses been affected by the pandemic, but the student educational pathways in nursing and other health professions have been disrupted. While this was a concern for many rural and underserved communities prior to the pandemic, this problem heightened to a critical level. Student clinical experiences, a necessity for credentials among health professions programs, were frequently cancelled due to low supply of personal protective equipment (PPE); lack of preceptors due to changing operating procedures; and social distancing protocols that limited the capacity of sites to include additional personnel (Jones et al., 2021; Redden, 2020). Throughout the pandemic, many elective cases were cancelled to prepare for potential patient surges, further reducing the number of healthcare workers who could serve as preceptors.
As a result of these challenges, nursing and other health professions training programs were forced to use virtual clinicals or simulation experiences (Fogg et al., 2020). These changing methodologies resulted in fewer opportunities for exposure to and collaboration with other professions, raising concerns that learners will enter the workforce ill-prepared for both intra- and interprofessional practice (NASEM, 2021b). In a report about a study of the effects of COVID-19 on the healthcare workforce, a healthcare leader expressed concerns that, without these interprofessional interactions, students would return to "a more institutional model we have fought years to get away from" (Jones et al., 2021, p. 50). Returning to this previous model would risk losing decades of progress toward promoting interprofessional practice at the student level.
The World Health Organization (WHO) describes interprofessional practice (IPP) as "…multiple health workers from different professional backgrounds work[ing] together with patients, families, caregivers, and communities to deliver the highest quality of care" (WHO, 2010, p. 7). Interprofessional education (IPE) is the educational practice where those in two or more professions collaborate to "learn about, from, and with each other" (WHO, 2010, p. 7). IPE helps healthcare workers achieve IPP. The WHO deemed that interprofessional education and practice (IPEP) is vital to attain a workforce that is ready and able to care for local health needs through teamwork and collaboration (WHO, 2010).
Interprofessional teams are critical in the care of acute, chronic, and complex health and social support needs of COVID-19 patients (Michalec & Lamb, 2020). IPE and IPP are so essential to care that accreditation bodies have come together to provide guidance about how to embed these activities throughout all health professions programs (Health Professions Accreditors Collaborative, 2019). Nursing Now USA and the Robert Wood Johnson Foundation Future of Nursing: Campaign for Action also recognize the value of interprofessional teams. They have both called for nurses to promote equity by breaking down interprofessional barriers for the betterment of population health (Holloway et al., 2021; NASEM, 2021a). Furthermore, healthcare workers undergoing pandemic stressors are now reporting a stronger emphasis on cooperation and collaboration within and across healthcare professions (Langlois et al., 2020).
IPEP has the potential to improve patient outcomes and satisfaction, enhance workforce satisfaction, and reduce cost, all while expanding the current workforce and preparing the pipeline (Reeves et al., 2016). When delivered intentionally, IPEP has the potential to achieve the Quadruple Aim (i.e., improved quality, increased population health, reduced costs, and improved clinician experience), with teamwork playing a large part in the achievement of the fourth aim: addressing the needs of healthcare workers, and reducing stressors experienced by the past, current, and future healthcare workforce, including nurses (Bachynsky, 2020; Bodenheimer & Sinsky, 2014).
Combined with the pre-existing and worsening nursing workforce shortage, surges of patients with COVID-19 have exacerbated the need to implement strategies to build a pathway to expand the current and future nursing workforce. Ideal strategies connect education (i.e., health professions students) and practice (i.e., current health professionals) to create academic-practice partnerships, based on the demand and supply for healthcare professional skills. With an emphasis on supply and demand of skills, these strategies can not succeed if executed in a professional silo; teamwork and collaboration are keys to efficiency, effectiveness, and resilience.
NursingNow is a global campaign, started in 2018, with the goal to improve health for all by utilizing and elevating the status of nurses (Holloway et al., 2021). The NursingNow mission is clear, stating "…nurses are vital agents of change who can improve health and transform health care" (Holloway et al., 2021, p. 4). The NursingNow initiative, along with The Future of Nursing 2020–2030 document, both call for nurses as leaders of collaborative efforts with other healthcare professions to promote health and well-being for all (Holloway et al., 2021; NASEM, 2021a).
The nursing workforce, as the last line of defense for patients, is at the center of the healthcare team; nurses interface with most professions and settings. NursingNow is a global campaign, started in 2018, with the goal to improve health for all by utilizing and elevating the status of nurses (Holloway et al., 2021). The NursingNow mission is clear, stating "…nurses are vital agents of change who can improve health and transform health care" (Holloway et al., 2021, p. 4). The NursingNow initiative, along with The Future of Nursing 2020–2030 document, call for nurses to serve as leaders of collaborative efforts with other healthcare professions to promote health and well-being for all (Holloway et al., 2021; NASEM, 2021a). Nurses have demonstrated that they are in an ideal position on the healthcare team to meet the additional demands placed on health services (e.g., contact tracing, testing, vaccine administration) and increased demand for staff, resources, policies, and supplies by the COVID-19 pandemic, all of which threaten an already overtaxed system (Digby et al., 2021). In this role, nurses are poised to lead efforts that advance health, including teamwork and collaboration efforts that promote the well-being of the team and strengthen the interprofessional pathway, and to centralize a system that partners education and practice, filling an acute human resource need in clinical settings.
The purpose of this article is to describe two nurse-led innovations that centralized and coordinated the connection of education and practice. These innovations engaged interprofessional students as members of the healthcare team to meet the healthcare needs of a population. We offer two exemplars that highlight the work and outcomes of nurse leaders in North Carolina to match health professions students with clinical practice settings to deliver services during the pandemic. The article illustrates opportunities for improvement and suggests recommendations for future work in disaster response and interprofessional workforce development. Our focus is on multiple health professions; however, we have taken the NursingNow mission to elevate nurses to leadership positions by highlighting specific opportunities to lead the call for a nurse-led flexible system that can proactively respond to patient care needs of a given population. Such a system would include patient care skills of various health professions across the continuum of learning.
Online J Issues Nurs. 2023;28(2) © 2023 American Nurses Association
